J Korean Surg Soc.  2013 Mar;84(3):185-188.

Biliary injury after cholecystectomy in a patient with severe right liver atrophy

• Paik KY

Abstract

We report a case of bile fistula after cholecystectomy in a patient with severe right liver atrophy, which was managed by endoscopic nasobiliary drainage and conservative treatment. The patient was a 76-year-old man with a sudden onset in the right flank and abdominal pain. Computed tomography revealed calculous cholecystitis and severely atrophied right lobe of the liver. Gallbladder was located in the superior-posterior portion of the liver as opposed to the normal position. The patient underwent cholecystectomy and showed massive bleeding and bile leakage at the gallbladder bed during operation. A bile fistula was detected three days after surgery, which was managed by interventional bile drainage. Right liver agenesis or severe atrophy is rare. Additionally, the report of combined bile duct injury after cholecystectomy in these settings is extremely rare.

Keyword

Biliary injury; Liver; Atrophy

MeSH Terms

Abdominal Pain
Atrophy
Bile
Bile Ducts
Cholecystectomy
Cholecystitis
Drainage
Fistula
Gallbladder
Hemorrhage
Humans
Liver

Figure

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  Fig. 1 (A) Severe atrophy of right liver lobe. It looks like mass or nodular lesion (white arrow). (B) Hypertrophied left lateral and medial segments. (C) Arrowhead indicates right hepatic vein, which is draining into vena cava. (D) Suprahepatic location of gallbladder with inflammation.

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  Fig. 2 (A) Bile leakage (arrow) from bile duct suspicious of right hepatic duct or segment 4 branch revealed by endoscopic retrograde cholangiopancreatography. (B) Endoscopic nasobiliary drainage into the left hepatic duct.

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